Provider Demographics
NPI:1881142487
Name:LOWE, JACLYN R (RN)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:R
Last Name:LOWE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W BASS ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5011
Mailing Address - Country:US
Mailing Address - Phone:407-935-1192
Mailing Address - Fax:877-286-6953
Practice Address - Street 1:309 W BASS ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5011
Practice Address - Country:US
Practice Address - Phone:407-935-1192
Practice Address - Fax:877-286-6953
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9203575363LF0000X
FL9203575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily